Diseases of the Heart and Circulation

As a senior house officer at the Royal Brompton Hospital in 2005 I came across several exceptionally detailed records of examination findings dating back to the 1950s. These entries were by the late Paul Wood. My subsequent inquiries helped me discover Diseases of the Heart and Circulation , the legacy of one of the greatest names of British cardiology.

Born in India in 1907, Wood attended medical school in Melbourne, Australia. He was house physician at the Royal Brompton before becoming a consultant in the late 1940s. Wood was a master of clinical cardiology, renowned for his extraordinary bedside examination skills and diagnostic …


Primary Non-congenital Disease of the Eight
Heart.?Syers1 states that it is not unusual for a middle-aged patient to present himself complaining of shortness of breath and dropsy, and in whom the heart action (is regular and there is no evidence of valvular disease. The symptoms are generally of insidious onse j.
In some cases there may be moist sounds at the lung bases, but generally they are quite clear. As a rule, the quanity of urine is quite up to the average, and it hardly ever contains albumen. The pulse is usually regular and of good volume, and there may be some hypertrophy of the left ventricle.
In some cases the heart dulness is increased to the right, but usually this is not the case.
The most obvious explanation of these cases would be dilatation of the right heart from chronic bronchitis and emphysema, but in the cases here considered the history and physical signs negative sucb a theory. The most probable view is that the right side of the heart is the seat of degenerative changes> the left side being relatively intact. Such a patient, when first seen, may present most of the features of advanced mitral disease, with the important except tions that the action of the heart is regular, there 13 no bruit, and the quality of the pulse is good. I? treating such cases a combination of digitalis and caffein is of very great service. This, with rest, will often restore a patient, for a time at least, to com* parative health.
Cardiac Dulness in Cancer.?Gordon2 states that reduction or loss of cardiac dulness is common i? cases of cancer, especially in cases of abdominai cancer towards their end. It may precede cachexia, marked wasting, and loss of skin elasticity, seems absent in the earliest stages. When presen^ in a doubtful case the sign is very suggestive 0 the existence of a cancer, and if absent in a doubtfu case of considerable duration it is slightly suggestive that the case is not one of cancer. ^ A assessing the value of this physical sign it is 0 course necessary to exclude the existence of all ordinary causes of alteration in the area of car ,1f^ dulness. The explanation appears to be that t margins of the lungs extend across the front 0 the heart owing to a loss of elasticity similar to t ? induce a feeling of faintness, and the same symptoms niay occur when a large quantity of ascitic nui is removed, and in susceptible individuals wlien tne bladder is emptied or fseces discharged. ii<veiy im the diaphragm descends, the intra-abdomina^ are compressed and the blood is squeezed in o right heart; also the pulmonary vessels expand witn each inspiration and suck the blood out of e ? ?
heart. If the lower sternal region be percussed m the standing and then in the recumbent position, the note from being resonant becomes dull^or flat. This is the cardiosplanchnic phenomenon. _ compression of the abdomen will exaggerate it; on tne other hand a few forced inspirations will abolish tne dulness. The statements above afford an exp an^ tion of the phenomenon?it is due t? a falling or over-filling of the right ventricle with blood on recumbency. The elicitation of the cardiosplanchnic phenomenon would prove valuable in the diflerentiai diagnosis of a dilated heart from a pericardial exudate , *n the latter affection it would not be elicited. ^ Idiopathic syncope and vertigo and the vertiginous attacks of Glenard's disease may be attributed to a defective splanchnic vasomotor mechanism ; in sue conditions the cardiosplanchnic phenomenon is exaggerated. The predominance of dyspnoeic attacks at night in cardio-respiratory affections can be explained by the augmented blood-supply to the riaht ventricle, the mere result of recumbency. 0 UP right position instinctively assumed in orthopnea is due, not only to the fact that the extraordinary muscles of respiration may work to better advantage, but also to the additional reason that the blood from the right heart is enabled to gravitate to the splanchnic area. In syncope the object to be achieved is the determination of blood, not so much to the anaemic brain as to the heart. This may be done by compression of the abdomen, either intermittently or by a firm cushion applied by a bandage.
Exercise in Heart Disease.?Davis7 enumerates, as possible methods, massage, Swedish gymnastics, mountain climbing, and resistance gymnastics.
Drugs, as digitalis, may temporarily contract the heart when dilated, but permanent recovery of strength can only be obtained by improving the nutrition of the heart and by relieving it of excess of work. Both results are obtainable by judicious exercise of the voluntary muscles. The first effect of muscular work is to increase blood-pressure, but this is followed by a more persistent fall due to dilatation of the arterioles. The primary increase is in proportion to the degree of exertion, the secondary fall is more dependent on the duration of the movements and the size and number of the muscles used. In prescribing exercises the first rule should therefore be that the muscular effort should be slight, but numerous large muscles must be used. Respiration should be deepened but not hurried. The exercises should be graduated, at first only the lightest should be used, and subsequently they should be increased in vigour. Massage and resistance gymnastics are the feeblest forms of exercise, and should be first used in all cases.